Provider Demographics
NPI:1306154141
Name:ARNOLD, ANNETTE (LLPC,CAAC,LBSW,ADS)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:LLPC,CAAC,LBSW,ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19217 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2236
Mailing Address - Country:US
Mailing Address - Phone:313-399-3712
Mailing Address - Fax:313-521-9125
Practice Address - Street 1:22777 HARPER AVE
Practice Address - Street 2:SUITE 208A
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1868
Practice Address - Country:US
Practice Address - Phone:313-399-3712
Practice Address - Fax:313-521-9125
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-01677101YA0400X
MI6401010508101YM0800X
MI6802080312104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker